脑梗死患者血浆同型半胱氨酸与颅内动脉狭窄的相关性

目的 探讨脑梗死患者血浆同型半胱氨酸(plasma homocysteine,pHcy)与颅内动脉狭窄的相关性.方法 对185例脑梗死患者行MRA检查并按动脉硬化程度分组,比较不同程度颅内动脉硬化组患者血浆pHcy水平的变化.记录所有患者年龄、性别、吸烟、饮酒、高血压、糖尿病等传统危险因素,以及pHcy、三酰甘油(TG)、胆固醇(TC)等血生化指标.结果 (1)正常组、动脉硬化组和动脉狭窄组脑梗死患者高pHcy检出率分别为12.5%、37.5%、57.0%,随颅内动脉病变程度加重高pHcy检出率增高(P<0.05).(2)经多元逐步Logistic回归分析发现,pHcy水平升高是颅内动脉狭窄的独立危险因素(OR=2.033,95%CI:1.041～3.967,P<0.05).结论 pHcy水平升高与颅内动脉硬化程度有关,是脑梗死患者颅内动脉狭窄的独立危险因素.     

急性脑梗死患者脑动脉狭窄的分布及危险因素分析

目的探讨急性脑梗死患者脑动脉狭窄的分布特点及危险因素。方法 232例经MRI、MRA检查的脑梗死患者及健康对照者,存在狭窄患者根据狭窄部位分为单纯颅内狭窄组、单纯颅外狭窄组、颅内外狭窄组,分析脑动脉狭窄的分布特点及影响因素。结果 (1)单纯颅内动脉狭窄者114例(62.0%),单纯颅外动脉狭窄者30例(16.3%),合并颅内外动脉狭窄者40例(21.7%)。前循环狭窄(76.6%)比后循环(33.7%)常见。分别主要发生在MCA(64.4%)、PCA(53.8%)。(2)年龄、高血压、糖尿病、吸烟、纤维蛋白原(fibrinogen,Fbg)为脑动脉狭窄的独立危险因素(OR分别为1.049、10.063、3.873、3.311、6.085)。(3)高血压、糖尿病、吸烟为单纯颅内动脉狭窄的独立危险因素(OR分别为10.779、3.593、4.408),高血压、糖尿病、Fbg为单纯颅外动脉狭窄的独立危险因素(OR分别为6.143、8.179、2.410)。(4)合并颅内外动脉狭窄组CRP(C-reactive protein,C-反应蛋白)平均值显著高于单纯狭窄的两组(P=0.001、P=0.018),单纯狭窄组间比较无统计学意义。结论 (1)研究人群中脑动脉狭窄以颅内动脉狭窄为多见。(2)年龄、高血压、糖尿病、吸烟、Fbg为脑动脉狭窄的独立危险因素。(3)高血压、糖尿病为单纯颅内、颅外动脉狭窄共同的独立危险因素。吸烟为单纯颅内动脉狭窄的独立危险因素。Fbg为单纯颅外动脉狭窄的独立危险因素。(4)CRP可能为脑动脉狭窄的炎性预测因子。     

缺血性脑血管病患者脑动脉狭窄与血压变异性的相关性

目的 探讨缺血性脑血管病患者脑动脉粥样硬化性狭窄与血压变异性的关系. 方法 选择自2006年11月至2010年6月在淮南市第一人民医院神经内科住院的206例缺血性脑血管病患者为研究对象,对患者进行连续主动脉弓+全脑血管造影检查,并作动脉血压监测.根据造影结果分组,并对其临床资料进行回顾性分析. 结果 (1)206例患者中75例颅内外动脉无狭窄,131例存在脑动脉狭窄,其中42例仅有颅外动脉狭窄,38例仅有颅内动脉狭窄,51例颅内外狭窄并存;颅外动脉狭窄的发生率(71.0％,93例)高于颅内动脉(67.9％,89例).(2)与颅内外动脉无狭窄组比较.单纯颅外动脉狭窄组、单纯颅内动脉狭窄组、颅内外动脉狭窄并存组24h平均收缩压、舒张压标准差,白昼平均收缩压、舒张压标准差,夜间平均收缩压、舒张压标准差均明显增大,差异有统计学意义(P＜0.05).(3)收缩压变异系数与脑动脉狭窄患病率成正相关(r=0.918,P=0.002),而舒张压变异系数与脑动脉狭窄发患病率无明显相关性(P＞0.05);24 h平均收缩压与脑动脉狭窄患病率成正相关(r=0.936,P=0.001),而24 h平均舒张压与脑动脉狭窄患病率无明显相关性(P＞0.05).(4)多元回归分析显示:24h平均收缩压、收缩压变异系数与颅内外动脉狭窄患病率呈明显正相关.(5)血脂异常是单纯颅内动脉狭窄的独立危险因素;高龄是单纯颅外动脉狭窄的独立危险因素;吸烟是单纯颅内动脉狭窄及单纯颅外动脉狭窄的独立危险因素;高血压是单纯颅外动脉狭窄及颅内外动脉狭窄并存的独立危险因素. 结论 在缺血性脑血管病患者中,脑动脉狭窄与平均血压标准差、收缩压变异系数独立相关.高血压、高脂血症、冠心病、吸烟、高龄、糖尿病和高同型半胱氨酸血症等危险因素与脑动脉狭窄的分布模式有一定关系.动脉血压变异性是缺血性脑血管病患者颅内外狭窄的独立危险因素,但与狭窄的分布模式无相关性.     

数字减影血管造影检查的缺血性脑血管病患者脑动脉狭窄分布及危险因素的研究

目的通过数字减影血管造影(DSA)检测分析缺血性脑血管病(ICVD)患者的脑动脉狭窄特点,以及不同脑动脉狭窄与危险因素之间的关系。方法 2010年2月-2017年2月本院收录的1304例行DSA检查的ICVD患者的脑动脉狭窄分布与危险因素之间的关系进行分析。结果颅内动脉与颅外动脉以及脑动脉狭窄组与无狭窄组比较,脑动脉狭窄组与颅外动脉组在各危险因素上均表现出较高的检出率;此外,颅外动脉的血管狭窄率显著性高于颅内动脉。结论颅外冬眠狭窄率明显高于颅内,高龄、男性、抽烟、喝酒、高血压、血脂水平高和高尿酸血症是脑动脉狭窄最常见的危险因素。     

颅内外动脉狭窄与脑血管病危险因素和发病率的相关关系

目的 探讨脑血管病(CVD)患者的颅内外动脉血管狭窄情况及其与CVD危险因素和发病率的关系.方法 对160例CVD患者行数字减影血管造影(DSA)检测,对颅内外动脉血管的狭窄率、狭窄程度、分布特点和危险因素进行统计分析.结果 CVD患者颅内外动脉狭窄的发生率为65%,高危因素中高血压和糖尿病多分布于颅内动脉狭窄患者中(P＜0.05), 而吸烟和高脂血症多分布于颅外动脉狭窄患者中(P＜0.05);中重度血管狭窄组的脑梗死和TIA发病率高于脑出血组(P＜0.05).结论 高血压、糖尿病、高脂血症和吸烟易导致颅内外动脉狭窄,而后者是CVD发病的重要因素之一;随狭窄程度的增加CVD的发病率升高.     

代谢综合征与颅内外动脉粥样硬化性狭窄的相关性研究

目的:探讨代谢综合征(Metabolic syndrome,MS)与颅内外动脉粥样硬化性病变的相关性。方法:连续收集579例因急性脑梗塞或血管性危险因素入院的患者,借助经颅多普勒超声和/或核磁共振血管成像明确有无颅内外动脉粥样硬化性狭窄,分为狭窄组和非狭窄组;采用IDF的MS诊断标准,明确两组MS的发生率;分析颅内外动脉粥样硬化性狭窄的危险因素,并探讨MS与颅内、颅外动脉粥样硬化性狭窄的相关性。结果:1、狭窄组和非狭窄组MS的发生率分别为71.26%,58.43%,两组比较有统计学差异(P=0.0015)。2、与脑动脉粥样硬化性狭窄相关的危险因素依次为:脑梗塞病史、高血糖、高胆固醇血症、高血压、低HDL血症,年龄,MS并非脑动脉粥样硬化性狭窄的独立危险因素,OR0.798。3、MS与颅内动脉粥样硬化性狭窄相关,OR1.736,但其风险依赖于其组分中的高血糖、高血压及低HDL血症;MS与颅外动脉粥样硬化性狭窄不相关,OR1.466。结论:MS不是脑动脉粥样硬化性狭窄的独立危险因素,MS与颅内动脉粥样硬化性狭窄相关,但这种危险性依赖于MS各组分,MS与颅外动脉粥样硬化性狭窄无相关性。     

缺血性卒中患者颅内动脉狭窄的相关危险因素分析

目的 探讨颅内动脉狭窄的狭窄程度、相关危险因素与缺血性脑卒中的关系,为缺血性卒中的防治提供重要依据.方法 90例缺血性卒中患者根据全DSA检查结果分为非狭窄组(狭窄<30%)与颅内动脉狭窄组(狭窄≥30%或闭塞),分析颅内动脉狭窄程度与年龄、性别、高血压、糖尿病、高脂血症、冠心病、家族史、总胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白胆同醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白 A1(ApoA1)、载脂蛋白B(ApoB)、血清脂蛋白(Lpa)等相关危险因素的关系.结果 (1)本组患者颅内动脉狭窄发生率为67.78%,发生率最高为大脑巾动脉,其次颈内动脉颅内段和椎基底动脉颅内段,发生率最低为大脑后动脉.(2)有高血压、糖尿病的缺血性卒中患者容易发生颅内动脉狭窄,其同归系数、OR值、P值分别为1.659、5.256、0.002,1.657、5.241、0.046.(3)颅内动脉狭窄组HDL-C含量[(0.99±0.30)mmol/L]比非狭窄组[(1.30±0.50)mmol/L]明显降低,差异有统计学意义(t=3.603,P=0.001).(4)年龄、性别、吸烟、既往卒中史、脑血管病家族史、TC、TG、LDL-C、ApoA1、ApoB、Lpa在两组间比较差异无统计学意义(P>0.05).结论 缺血性卒中患者颅内血管狭窄的主要危险因素有高血压、糖尿病,保护因素有HDL-C.     

经颅多普勒和颈动脉超声检测高血压患者无症状性颅内外动脉粥样硬化病变

目的分析无脑缺血症状的高血压患者颅内外动脉粥样硬化病变的发生频率及分布特征,并探讨其危险因素。方法对106例无脑缺血症状的高血压患者采用经颅多普勒超声(Transcranial Doppler,TCD)和颈动脉超声判断颅内外动脉粥样硬化病变,分析各危险因素的影响。结果 69例有颅内外动脉粥样硬化病变,其中23例颅内动脉狭窄,2例颅外颈动脉狭窄或闭塞。颅内动脉狭窄发生率明显高于颅外颈动脉狭窄或闭塞(P<0.05)。Logistic多元回归分析显示与年龄、高血压病病程及高脂血症相关。结论无脑缺血症状的高血压病患者,半数以上存在颅内外动脉粥样硬化病变,年龄、高血压病病程和高脂血症是颅内外动脉粥样硬化病变的独立危险因素。     

复发性脑梗死危险因素及与动脉狭窄的相关性

目的探讨复发性脑梗死的危险因素及与颅内动脉粥样硬化性狭窄(ICAS)、颅外动脉粥样硬化性狭窄(ECAS)的相关性。方法收集2017-08—2018-08就诊于中国人民解放军中部战区总医院的急性脑梗死患者132例,均行320排CT血管成像(CTA)检查,根据既往有无脑梗死史分为复发组(57例)及初发组(75例),分析复发性脑梗死的危险因素及与颅内外动脉粥样硬化性狭窄的相关性。结果单因素分析显示,年龄、甘油三酯(TG)等差异有统计学意义(P0.05);ECAS、颅内外动脉狭窄程度、ICAS等组间差异有统计学意义(P0.05或0.01)。多因素非条件Logistic回归分析显示,TG是复发性脑梗死的独立危险因素。结论脑梗死的复发受年龄、TG、ICAS、ECAS、颅内外动脉狭窄程度等多种因素影响,其中TG是其独立危险因素。通过控制相关危险因素,积极预防颅内外动脉粥样硬化,将有利于降低脑梗死的复发风险。     

不同年龄短暂性脑缺血发作病人头颈部CT血管造影的临床分析

目的探讨不同年龄短暂性脑缺血发作(TIA)头颈部CT血管造影(CTA)特点。方法 200例TIA病人根据年龄分为青年组(n=63)和中老年组(n=137),分析两组病人的一般资料、血液学指标及影像学结果 ,计算颅内、外血管狭窄的发生率,并进行统计学分析。结果两组病人TIA相同的危险因素是吸烟、饮酒与高尿酸血症。青年组的危险因素是高脂血症、肥胖、失眠与高同型半胱氨酸血症。中老年组的危险因素是糖尿病、高血压病与周围血管病(P0.05)。200例病人中,128例(64.00%)病人共163支脑血管存在不同程度狭窄或闭塞,其中颅外动脉狭窄发生率为52.15%(85/163)略高于颅内动脉(47.85%,78/163)。青年组颅内动脉狭窄占11.66%,中老年组颅外动脉狭窄占29.48%,两组颅内外动脉狭窄分布差异具有统计学意义(P0.05)。结论不同年龄TIA病人有不同临床和影像学特点,颅内、外动脉粥样硬化性狭窄随年龄变化而呈特征性分布。不同年龄病人应采取针对性的个体化防治措施。     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.     

Relationship Between Sluggish Cognitive Tempo and Age and IQ in Preschool and School-Age Children and Adolescents with Autism and with ADHD

Journal of Autism and Developmental Disorders - Relationships between sluggish cognitive tempo (SCT) and age and IQ were investigated in children with autism and/or ADHD covering broader age and IQ...     

Synaptic plasticity and learning and memory: LTP and beyond.

Long-term potentiation (LTP) of synaptic activity is by far the most popular and widely researched model of synaptic plastic changes that might occur during learning. Numerous recent reports, however, have not found a correlation between the inducibility of LTP in the hippocampus and the ability of animals to learn hippocampus-dependent tasks. For example, some experiments with gene deletion (knockout) mice strains have shown that in some strains LTP is not inducible in the dentate gyrus, in area CA3, or CA1, but the animals are still able to learn spatial tasks. This apparent mismatch has rejuvenated the discussion concerning whether LTP is a good model for mechanisms that underlie memory formation in the nervous system. This review analyzes the conditions under which LTP is induced or learning takes place and suggests reasons for the mismatches that can occur and what we can learn from them. High-frequency stimulation protocols and in vitro assays cannot be seen to resemble natural firing patterns or conditions found in the brain. More physiological experimental conditions, especially in vivo recording in awake animals, could lead the way to the development of improved models of learning mechanisms that better correlate with learning abilities of animals.